CELCAR Screening Form For this study we are looking for adults over 18 years old, who are in good health (no unstable or serious illness) and are able to attend the clinic for approximately 15-20 minutes for a blood draw. 3 collection tubes of maximum 10 mL each will be collected. Your blood sample will be used for testing and biomarker analysis. It may be processed to isolate the peripheral blood mononuclear cells (PBMC, also called white blood cells), the plasma and/or the serum. There will be no genetic testing. Blood samples will be taken at the RDC clinic, processed, labelled with your trial identification number and sent to CellCarta (Sydney) for laboratory test workup. Any remaining blood that is not used in the analysis, will be destroyed. Are you still interested in participating? Yes No Screening QuestionsGreat, let’s go through the screening criteria to assess your eligibility.Trial Coordinator Initials Gender? Male Female Could you please let me know your age?Must be aged over 18 Not Eligible Have you donated blood recently?current guidelines: a rest time proportional to 56 days per 500 mL of donated blood will be observed, which corresponds to 1 day of rest for each ~9 ml of blood drawn. Yes No Not Eligible Do you have any chronic or serious illnesses?(eg kidney, liver, GIT, heart condition, diabetes, lung condition, malignancy) or any chronic disease Yes No Not Eligible Are you regularly taking any medications or supplements? Yes No Please specifyDo you have a history of hematologic diseases (eg known susceptibility to thrombosis)? Yes No Not Eligible Do you have a history of problems with needles or blood tests?Such as issues with fainting/dehydration or bruising? Yes No Not Eligible Are you currently experiencing any cold or flu symptoms (e.g., fever, sore throat, runny nose)? Yes No Not Eligible Have you had any acute sickness in the last 2 months? Yes No Not Eligible Are you currently pregnant or lactating, or have you given birth in the last 6 months? Yes No Not Eligible Is the participant Eligible? Yes No Screenfail reasonIf passed - please allocate Participant ID:If the participant is eligible, please confirm whether they are confirmed or to be placed on the Wait List.
